What is Abuse?

Physical injuries can occur where there is no satisfactory explanation, definite knowledge, or a reasonable suspicion that injury was inflicted with intent, caused through lack of care by the person having custody, charge or care of that person.

The following list may be indicators of many different problems, it is important not to jump to the wrong conclusion too quickly, some of the indicators could be as follows -

• History of unexplained falls
• Unexplained bruising - in well protected areas or soft parts of the body
• Bruising in different stages of healing
• Unexplained burns - unusual location / type
• Unexplained fractures to any part of the body
• Unexplained lacerations or abrasions
• Slap, kick, punch or finger marks
• Injury shape similar to an object
• Untreated medical problems
• Weight loss due to malnutrition or dehydration

Sexual abuse is the involvement of vulnerable adults in sexual activities, which they do not fully comprehend, to which they are unable to give consent, to which they object or which may cause them harm.

The following list may be indicators of many different problems - it is important not to jump to conclusions too quickly, some of the indicators could be as follows -

• Sudden change in behaviour
• Sudden onset of confusion
• Incontinence
• Withdrawal
• Overt sexual behaviour / language by the vulnerable adult
• Self-inflicted injury
• Disturbed sleep pattern / poor concentration
• Difficulty in walking
• Torn, stained underwear
• Love bites
• Pain or itching, bruising or bleeding in the genital area
• Sexually transmitted disease / urinary tract / vaginal infection
• Bruising to upper thighs and arms
• Frequent infection
• Severe upset or agitation when being bathed etc.
• Pregnancy in a person unable to consent

Financial or material abuse can take the form of fraud, theft or using of the vulnerable adults property without their permission. This could involve large sums of money or just small amounts from a pension or allowance each week.

It is important not to jump to the wrong conclusions too quickly; however the following is a list of possible indicators of financial abuse -

• Sudden inability to pay bills
• Sudden withdrawal of money from an account
• Person lacks belongings that they can clearly afford
• Lack of receptivity by the persons relatives to necessary expenditure
• Power of attorney obtained when the person is unable to understand what they are signing
• Extraordinary interest by family members in the vulnerable adults assets
• Recent change of deeds o the house
• Carers main interest is financial with little regard for the health and welfare of the vulnerable adult
• The person managing the finances is evasive and uncooperative
• Reluctance to accept care services
• Purchase of items that the individual does not require or use
• Personal items going missing
• Unreasonable or inappropriate gifts

This can include intimidation, humiliation, shouting, swearing, emotional blackmail and denial of basic human rights. Using racist language, preventing someone from enjoying activities or meeting friends.

The following may be indicators of many different problems, it is important not to jump to the wrong conclusions too quickly -

• Ambivalence about carer
• Fearfulness, avoiding eye contact, flinching on approach
• Deference
• Insomnia or need for excessive sleep
• Change in appetite
• Unusual weight loss / gain
• Tearfulness
• Unexplained paranoia
• Low self esteem
• Confusion, agitation
• Coercion
• Possible violation of human and civil rights
• Distress caused by being locked in a home or car etc.
• Isolation - no visitors or phone calls allowed
• Inappropriate clothing
• Sensory deprivation
• Restricted access to hygiene facilities
• Lack of personal respect
• Lack of recognition of individuals rights
• Carer does not offer personal hygiene, medical care, regular food/drinks
• Use of furniture to restrict movement

A person can suffer because their physical and/or psychological needs are being neglected by a carer. This could include failure to keep someone warm, clean and well nourished or neglecting to give prescribed medication.

The following list may be indications of many different problems, it is important not to jump to the wrong conclusion too quickly.

• Poor environmental conditions
• Inadequate heating and lighting
• Poor physical condition of the vulnerable adult
• Persons clothing is ill fitting, unclean and in poor condition
• Malnutrition
• Failure to give prescribed medication properly
• Failure to provide appropriate privacy and dignity
• Inconsistent or reluctant contact with health and social care agencies
• Isolation - denying access to callers or visitors

Discriminatory abuse is often on the grounds of: age, gender, race, culture, religion, sexuality or disability.

It also incorporates Hate crime and Mate crime. Mate crime occurs when vulnerable adults are "befriended" with the intention to abuse -

• derogatory comments
• harassment
• being made to move to a different resource/ service based on age
• being denied medical treatment on grounds of age or mental health
• not providing access

Mencap have recently launched the "Stand by Me" campaign to eradicate Hate and Mate crime.

Download Stand by Me Campaign here

Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment.

It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

The following list may be possible indicators of institutional abuse - it is important not to jump to the wrong conclusions too quickly.

• No flexibility in bed time routine and/or deliberate waking
• People left on the commode or toilet for long periods of time
• Inappropriate care of possessions, clothing and living area
• Lack of personal clothes and belongings
• Un-homely or stark living environments
• Deprived environmental conditions and lack of stimulation
• Inappropriate use of medical procedures e.g. enemas, catheterisation
• Batch care' - lack of individual care programmes
• Illegal confinement or restrictions
• Inappropriate use of power or control
• People referred to, or spoken to with disrespect
• Inflexible services based, on convenience of the provider rather than the person receiving services
• Inappropriate physical intervention
• Service user removed from the home or establishment, without discussion with other appropriate people or agencies, because staff are unable to manage the behaviours

Self-neglect – this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.